General Surgery 29 



disturbance. They commence as a tumefaction with edematous peri- 

 phery. Within some thirty-six hours the center of the swelling be- 

 comes soft and fluctuating and surrounded by a zone of indurated 

 granulation tissue. With deep abscesses the initial symptoms are 

 fever, refusal of food, pain upon motion of the aJBferted part, and 

 edema of more dependent parts. 



Most abscesses cause more or less functional disti irbance. Those 

 of the legs interfere with locomotion and even suppo-t of the body, 

 those about the throat inhibit deglutition and respiration, while pelvic 

 abscesses lead to suppression of defecation. 



The lesions with which abscesses are most liable to be con- 

 founded are cysts, soft tumors, and hernia (in abdominal and peri- 

 neal regions.) For differential diagnosis, the aspirating syringe 

 should be employed. When a cachectic, wasted condition of the sys- 

 tem is evident, the tuberculin test is indicated. 



Treatment. All acute abscesses in process of formation should 

 be closely watched. Wherever feasible, their development should be 

 assisted by hot fomentations. Immediately the presence of pus is 

 detected, the latter must be promptly evacuated by an incision made 

 with a sharp curved bistoury at the most dependent point. The open- 

 ing should be free to permit of subsequent drainage. In those cases 

 where the initial lesion is superficial and the fundus of the abscess 

 so deeply situated that its actual location can not be determined, it 

 is better to pass a probe or trocar through the initial lesion down to 

 the depths of the sac and thence towards the skin. Where the point 

 of the instrument is felt through the skin, the latter is snipped with 

 scissors and the passage through the connective tissue enlarged. 

 Some deep-seated abscesses, as in the parotid region, can only be 

 safely reached with a trocar after a simple skin incision is made. The 

 exit of the pus is to be favored by compression of the part and also 

 by injection of peroxide of hydrogen. The next step is to remove 

 any foreign body and then to irrigate the sac. Most authors recom- 

 mend irrigation with antiseptic solutions, but this is really a matter 

 of little moment, the object aimed at being to hasten repair by flush- 

 ing the cavity and washing away all trace of dead and moribund tis- 

 sue, and this can be accomplished equally as well with plain water as 

 with antiseptic solutions. A fountain syringe is well adapted for 

 this purpose. The drainage tract must be kept open for a few days. 

 The treatment of cold abscesses requires more energetic measures. 



